Type 2 diabetes is associated with high morbidity and mortality worldwide [1]. Patients with type 2 diabetes have become a major burden by complex treatment regimens and the health care systems both nationally and internationally [2,3]. Currently, pharmaceutical care interventions play crucial role in controlling of clinical parameters including fasting glycaemia and glycosylated haemoglobin in patients with Type 2 Diabetes [4]. Clinically, humanistic care is regarded as an additional care to improve patients’ compliance and enhance pharmaceutical care [5].

Nursing humanistic care is extremely important to promoting palliative care when it is based on Humanistic Nursing Theory [6]. Nursing humanistic care is scientific and practical and can be used as a scientific medical tool for the humanistic care ability of clinical nurses by applying attitude and practice evaluation system [7]. The humanistic partnership model in health care has been developed to improve the efficacy of pharmaceutical care by nursing professionals and partner patients [8]. In line with the evolution nursing care, nursing humanistic care provides a new implementation of the discipline's core concepts, which may integrate a social humanistic perspective into health care and potential impact on health care [9]. The positive nursing humanistic care highlights the value of multidisciplinary collaborative care for Type 2 diabetes patients, thereby supporting the effectiveness of daily humanistic care reminders in pharmaceutical care of patients with type 2 diabetes [10].

The purpose of this study was to investigate the clinical impact of daily humanistic care reminders on patients with type 2 diabetes. This study also raised awareness of the effect of nursing humanistic care on the control of parameters such as fasting glycaemia and levels of glycosylated haemoglobin (HbA1c) and demonstrated its applicability and impact in nursing research. It appears that daily nursing humanistic care is a promising tool for the renewal and the development of humanistic interventions for patients with type 2 diabetes.

Materials and Methods

Study Design and Setting

This was a control-paralleled study carried out in Jiangnan Community Health Service Center, from May 2019 to June 2020. All participants were selected because they were diagnosed type 2 diabetes. Patients were randomly divided into control and humanistic group. Control group patients (n = 600) received only pharmaceutical care, whereas humanistic care group patients (n = 600) received an extra humanistic care from a clinical pharmacist. This study was approved by the Medical Ethics Committee of Jiangnan Community Health Service Center. All patients provided written informed consent to participate in this study.

Participants

A total of 1200 patients with type 2 diabetes were recruited in this study. The target populations were diagnosed as diabetes with an HbA1c ≥ 7% (86 mmol/mol). The inclusion criteria were: more than 3 years type 2 diabetes; patients with normal daily communication. The exclusion criteria were: patients with uremia; patients with cancer.

Humanistic Care Interventions

Daily humanistic care reminders included diabetic education, interviews, face-to-face and telephone counseling to patients on health education and medication adherence. The clinical pharmacist also provided enquiry of specialized guidance for pharmaceutical care, dosage of drug, blood pressure, blood glucose, amount of exercise, sleep quality, dietary status and comfort of body.

Data Collection

The body mass index (BMI), blood pressure (BP), fasting blood glucose (FBG), glycosylated hemoglobin A1 (HbA1c), blood lipid levels [high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c), triglyceride (TG), total cholesterol (TC)], according to physician’s order were collected before and after 12-month follow-up. Medication adherence was assessed by the Morisky Green Levine Scale as described previously [11]. Two sets of questionnaires were used to evaluate the Diabetes Management Self-Efficacy Scale (DMSES) Malay version [12] and the Summary of Diabetes Self-Care Activities Scale (SDSCA) Malay version [13]. Satisfaction of patients was evaluated using five-point system medical treatment process (very satisfied: 5 points; satisfied: 4 points; no comment: 3 points; dissatisfied: 2 points; very dissatisfied: 1 point) [14]. Quality of life was accessed using five domains included energy, memory, diet, sex, and finance as described previously [15]. Insulin resistance was evaluated using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), which is derived from fasting insulin and glucose. An inflammatory score (IS) was used to measure the inflammation in patients with type 2 diabetes. Self-efficacy of diabetes was determined basing on the seven domains of diabetes self-management as described previously [16].

Statistical Analysis

The data were expressed as mean ± standard deviation (SD) or n (%). Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM, Armonk, New York, NY, USA). Differences between control and intervention groups were evaluated using independent t-test. The relationships between the humanistic care and glycaemic control were assessed using s Spearman correlation test method. P value considered significant if it is less than 0.05

Table 1: Baseline demographics and clinical characteristics of patients with type 2 diabetes.